Painful procedures and pain management in newborns admitted to an intensive care unit

Abstract

Objective: To characterize painful procedures, analgesic strategies, vital signs, and pain scores in hospitalized newborns. Method: This is a primary, observational, prospective clinical study, developed in a Brazilian public hospital. Demographic data, painful procedures, pain relief measures, vital signs, and pain scores were collected from the clinical records of 90 newborns admitted to the intensive care unit and evaluated between admission and the third day of admission. For statistical analysis, the software Statistic Package for the Social Sciences and the R Software were used. Results: Newborns underwent 2,732 painful procedures, 540 non-pharmacological and 216 pharmacological strategies. The most frequently performed procedure was the heel prick (20.96%). The most commonly recorded non-pharmacological strategy was dim lighting (28.33%) and continuous fentanyl (48.83%) was the main pharmacological measure adopted. Pain score and vital signs show variability in the period evaluated. Conclusion: Despite the high number of painful procedures, pain assessment records do not reflect procedural pain and the use of analgesic strategies was insufficient.

Pain management in hospitalized children: A cross-sectional study

“…Another point, which exemplifies the argument, is that 4.3% of children with pain did not have any drug prescribed and did not undergo any non-pharmacological intervention. Similar aspects were observed in a study with neonates subjected to 2736 painful procedures, in which 80.2% did not receive nonpharmacological measures that could be applied (15) . In this study, few non-pharmacological measures for pain relief were observed, according to medical records, although it is perceived in clinical practice, but with poor records.…”

“…When comparing this age group with adults, even though both have similar diagnoses, children receive less analgesia, and the younger they are, the less likely they are to have adequate analgesia in the medical environment (12) . This aspect is observed in a Brazilian investigation, in which of 2736 painful procedures in neonates, only 216 of these were performed with the aid of drugs (15) . This problem also occurs at the time of prescription of analgesics, either due to low training, low priority given to pain (p < 0.001) (6) , as well as the insecurity in prescribing as pediatric drugs are off label, that is, not tested in the pediatric population with low evidence regarding their use (1,11) .…”

“…In addition, the assessment needs to be carried out properly, but it is noted that the scales are used mechanically, which leads to non-representative pain scores. In a Brazilian investigation carried out in a Neonatal Intensive Care Unit, it is observed that in the period of 3 days, 90 newborns underwent 2732 painful procedures, but there were only 1257 reports in medical records with validated scales, and of these only 5.6% corresponded to the presence of pain ( 15 ) . In a study carried out in Israel with 82 pediatric nurses, 75% reported that they rarely or never used validated scales, but documented pain complaints in other places.…”

“…This management is considered as one of the most significant care functions that pediatric nurses face in the clinic ( 13 ) , by considering factors that can influence the characterization of pain by the child, such as age, neuropsychomotor development, behavior, and cognitive abilities ( 8 , 14 ) . To assist in this process, the use of instruments addressing multidimensional aspects, including behavioral and physiological indicators of pain ( 15 ) is recommended, such as NIPS (Neonatal Infant Pain Scale), FLACC (Face, Legs, Activity, Cry and Consolability), Wong baker FACES® Pain Rating Scale (FACES), Verbal Numerical scale (gold standard) ( 14 ) , and COMFORT scale ( 4 , 16 ) .…”